open access

Vol 69, No 3-4 (2019)
Review articles
Published online: 2019-10-31
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Management of melanoma metastases in the brain

Piotr Rutkowski, Dorota Kiprian, Monika Dudzisz-Śledź, Tomasz Świtaj, Radosław Michalik, Mateusz Spałek, Katarzyna Kozak, Tomasz Mandat
DOI: 10.5603/NJO.2019.0018
·
Nowotwory. Journal of Oncology 2019;69(3-4):86-96.

open access

Vol 69, No 3-4 (2019)
Review articles
Published online: 2019-10-31

Abstract

The basic principle for the diagnosis of melanoma metastases in the brain should be the management of multidisciplinary teams including at least a neurosurgeon, radiotherapist and clinical oncologist experienced in the treatment of melanoma and melanoma metastases in the CNS. Detection of brain lesions is associated with poor prognosis; metastases in the brain are the cause of death in 20–50% patients, and symptomatic tumours are a direct cause of death in about 90% patients. Treatment of melanoma with CNS metastases may include local management and/or systemic and symptomatic treat­ment. In the last 5 years, 10 new advanced melanoma drugs have been registered in Europe. Two-drug therapy anti-PD-1 and anti-CTLA-4 (nivolumab with ipilimumab) is the treatment of choice for asymptomatic melanoma metastases in the brain, while in the presence of BRAF mutations and asymptomatic metastases systemic treatment with BRAFi and MEKi may be the first-choice treatment.

Abstract

The basic principle for the diagnosis of melanoma metastases in the brain should be the management of multidisciplinary teams including at least a neurosurgeon, radiotherapist and clinical oncologist experienced in the treatment of melanoma and melanoma metastases in the CNS. Detection of brain lesions is associated with poor prognosis; metastases in the brain are the cause of death in 20–50% patients, and symptomatic tumours are a direct cause of death in about 90% patients. Treatment of melanoma with CNS metastases may include local management and/or systemic and symptomatic treat­ment. In the last 5 years, 10 new advanced melanoma drugs have been registered in Europe. Two-drug therapy anti-PD-1 and anti-CTLA-4 (nivolumab with ipilimumab) is the treatment of choice for asymptomatic melanoma metastases in the brain, while in the presence of BRAF mutations and asymptomatic metastases systemic treatment with BRAFi and MEKi may be the first-choice treatment.

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Keywords

melanoma; brain; metastases; radiotherapy; immunotherapy; BRAF inhibitors; MEK inhibitors

About this article
Title

Management of melanoma metastases in the brain

Journal

Nowotwory. Journal of Oncology

Issue

Vol 69, No 3-4 (2019)

Pages

86-96

Published online

2019-10-31

DOI

10.5603/NJO.2019.0018

Bibliographic record

Nowotwory. Journal of Oncology 2019;69(3-4):86-96.

Keywords

melanoma
brain
metastases
radiotherapy
immunotherapy
BRAF inhibitors
MEK inhibitors

Authors

Piotr Rutkowski
Dorota Kiprian
Monika Dudzisz-Śledź
Tomasz Świtaj
Radosław Michalik
Mateusz Spałek
Katarzyna Kozak
Tomasz Mandat

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